Matthew Holt interviews Ben Sawyer, Executive Vice President of CareLogistics, and Imran Andrabi, President and CEO of Mercy St. Vincent Medical Center, at the World Health Care Congress.
HIT Trends Summary for April 2011
By MICHAEL LAKE
This is a summary of the HIT Trends report for April 2011. You can get the current issue or subscribe here.
Europe. European progress reports on HIT show us that it’s evolving along many similar lines to current US efforts. One report highlights beacons of e-prescribing in Sweden and Estonia where scripts are stored centrally and available from any pharmacy. European states are also pursuing funding national centers of excellence in HIT. They are implementing EMR-like systems mostly less comprehensive than the US (34 countries); telehealth, most notably in the UK; and ID cards (24 countries). Governments are funding and because of that, also assessing results.
There are also success stories in cross-border health information exchange on a new website that gives us a comprehensive view into European HIE activities. There’s a report by the European standards community exploring barriers to personal health device interoperability, an issue that is holding back the world’s telehealth market. And CSC announced it is buying iSOFT, a subcontractor that’s been struggling, in hopes of faster progress in the UK’s National Programme for IT.
Incentives. Provider incentives have been in the news. CMS released a report on its quality (PQRI/PQRS) and e-prescribing (MIPPA) incentive programs for 2009 with providers earning $5,000 on average. Disincentives for the e-prescribing program begin in 2012 and the quality program in 2015. Quality data will be available over time on the CMS Physician Compare website.Continue reading…
Microsoft HSG Bets Future on Amalga
By JOHN MOORE
Microsoft’s Health Solutions Group (HSG), which has straddled the fence with consumer-facing (HealthVault) and corporate-facing (Amalga), is increasingly moving to the corporate side of the fence. Not that surprising considering that the consumer market continues to struggle (Google Health is in virtual mothball state, consumer adoption of HealthVault is nothing to write home about) and that HSG has now moved out of R&D and is now under the business solutions group, Dynamics. At the end of the day, HSG head Peter Neupert has to show that he can deliver the goods and Amalga is the horse he’s betting on (Note: Sentillion is there as well, but think of Sentillion as the gate-keeper to accessing Amalga).
Yet Amalga has gone through its share of birthing pains with some in the industry beginning to question its value.
Amalga has suffered from two significant problems, both inter-related. The first is that Amalga is an extremely powerful set of data aggregation and analytical tools, but it is more of a toolset then a product and this leads to long implementation time-frames and subsequently an inability to extract value quickly (ROI for Amalga is measured in years). For example, in 2009 Golden Living signed on to adopt Amalga and HealthVault. At last week’s Connected Health Conference, (CHC) Golden Living presented some remarkable results of how they are transforming long-term care through the use of Amalga. But in their presentation, Golden Living also stated that they knew full well when signing on to Amalga that this was going to be a multi-year effort and their implementation team has been given 5 years to put Amalga in place. Five years to fully implement a software solution is a very long-time and similar to the installs of the largest EHR systems. Unfortunately, many early Amalga customers did not have the foresight of Golden Living. In recent conversations with Microsoft, Chilmark has been told that significant resources are now being dedicated to improving time to value for Amalga. We’ll have to wait and see as the CHC sessions we attended on Amalga and HealthVault Community Connect, did not make this readily apparent.Continue reading…
Osama and the Cost of Health Care
In the near-decade since the Sept. 11, 2001, terror attacks, the “War on Terror” has cost the United States about $1.3 trillion, according to the National Center on Defense Information.
By comparison, it took just six months for the U.S. to spend that much money on health care, based on the $2.5 trillion spent in 2009.
Why does that comparison matter? Because as health care costs rise, they have begun to crowd out the money available in state and federal budgets for elementary and secondary education, infrastructure and other pressing human needs. The War on Terror isn’t going away and, in fact, may increase in intensity in the short term if fears of Al Qaeda retaliation prove true, so we won’t be de-funding the military to provide to get money to shore up crumbling bridges, roads and schools.
A 2009 report from the Office of Management and Budget put it plainly: “The Federal Government’s long-term fiscal shortfall is driven primarily by escalating health care costs…These growth rates are simply unsustainable and are why slowing the growth in health care costs is the single most important step we can take to put the Nation on firm fiscal footing.”
David Walker, the former U.S. Comptroller General turned crusader for fiscal responsibility, has said repeatedly, “If there’s one thing that could bankrupt American, it’s health care costs.”
Perhaps some of the patriotic unity inspired by the successful operation to kill Osama bin Laden can carry over to the efforts to responsibly control health care costs and preserve what makes America great. Not very likely – but, hey, one can always dream.
(Over)Simplifying EHR Usability
Dr. P patted the middle aged patient on the back, helped him off the elevated exam table and guided him to the chair by the sink. He picked up the chart and using the exam table as his desk he flipped through the chart, pulling out several pieces of paper, spreading them to his right, while making small talk with his patient. He reached into his pocket and pulled out a battered silver recorder and without any warning started dictating: “Mr. H is a 60 year old mildly obese gentleman presenting with…..“.
He had a pen now in his right hand, and as he was talking into his recorder, shuffling the various papers in front of him, he was also writing orders and prescriptions as fast as he was dictating. “….follow up in two weeks” was the last thing he said. He didn’t write that one down, but turned around, handed the patient a bunch of scripts, told him to stop by the front desk and make an appointment two weeks out and stop by the lab on the fourth floor to pick up a container for the urine test. Two minutes, tops, including the small talk. It was my turn now and I was sweating bullets because I knew exactly what he is about to say. “Can I do this in the EMR?”
EHR usability has finally arrived to Washington as the guest of honor at the most recent ONC HIT Policy Committee hearing. ONC seems to be considering the regulation and certification of EHR usability. NIST has created a testing procedure and just like its Meaningful Use testing procedures, it is superficial and doesn’t really test anything of any consequence. Those who represented “providers” and patients argued for the need to improve usability and those who represented academia and grant funded research argued for more funded research. Predictably, usability experts, argued for hiring more usability experts. Large vendors eloquently stated their objections to government mandating what EHRs should look like and small vendors argued that the more mandates, the better, since this will automatically remove the built-in competitive advantage of those with larger budgets and larger usability departments. As is customary, EHRs were compared to ATM machines, cars, iPhones, Google and a variety of “other industries” that are all so much more advanced than health care when it comes to usability.Continue reading…
Health Care in the Cloud: A ‘Case Study of What Not To Do’
Amazon Web Services (AWS), “the cloud” for many, experienced a serious interruption in service beginning on April 21st. The problem lingered for at least 6 days. Many websites that relied on Amazon services went down or saw their performance degraded during the event.
The AWS failure disproportionately affected startups like Foursquare, Quora and Reddit, companies that are “focused on moving fast in pursuit of growth, and less apt to pay for extensive backup and recovery services.”
One of the affected companies was a health care startup. What follows is a transcription (including typos) of an AWS Discussion Forum that this company initiated 24 hours after the outage began. The company’s contributions are in italics.
Life of our patients is at stake—I am desperately asking you to contact
Sorry I could not get through in any other way. We are a monitoring company and are monitoring hundreds of cardiac patients at home. We are unable to see their ECG signals since 21st of April. Can you please contact us? Or please let me know how can I contact you more ditectly. Thank you.Continue reading…
GOP Bill Promotes Greater Federal Control of Exchanges
By MERRILL GOOZNER
The latest Republican effort to undermine health care reform hits the House floor this week with the law of unintended consequences clearly in play. If the bill actually became law – an unlikely event since the Democrats still control the Senate and the White House – it would promote the federal takeover of health care, something Republicans have consistently opposed on the campaign trail.
The legislation, sponsored by Rep. Fred Upton, chairman of the Energy and Commerce Committee, withdraws federal financial support for state-based insurance exchanges. The exchanges, which will provide a clearing house for health insurance policies sold to individuals and small groups, are supposed to be up and running by January 2014.
The original Patient Protection and Affordable Care Act created an open-ended federal grant program to help states defray the costs of setting up the exchanges. Eliminating that support would save the federal government about $1.9 billion, according to the Congressional Budget Office, which released a cost estimate for H.R. 1213 late Thursday.Continue reading…
The Identity Theft Smoke Screen
Personal data privacy once again has taken front stage in Sorrel v. IMS Health, Inc.[1] Vermont passed the Vermont Confidentiality of Prescription Information Law that allows doctors which prescribe drugs to patients, to decide whether pharmacies can sell their prescription drug prescription records.[2] IMS Health as well as other health information companies contested the law, arguing that the law poses a restriction on commercial speech as access to such information helps pharmaceutical companies market their drugs effectively to doctors. The Supreme Court is now tasked with determining the constitutionality of the restriction on access to prescription information with regards to our First Amendment. [3]
However, this post is focused on the secondary effects asserted in amici curiae briefs supporting the petitioners of allowing companies to purchase such information, specifically the concern of data privacy and patient re-identification. [4] Under the Health Information Portability and Accountability Act (HIPAA), personal health information is de-identified by your local pharmacy prior to such information being shared with any third party. By de-identifying the data, your personal data cannot, it is believed, be linked or traced back to you. De-identifying your health information is a way for covered entities to share your information without your consent or authorization and in accordance with the law. The information once shared is completely anonymized. After the transfer to a third party, like IMS Health, your information is solely data of zeros and ones that translate to dates of dispensing and drug names. No longer does your prescription record list your name or month or day of birth. [5]Continue reading…
Connector Update
This report of recent activity in Massachusetts may be of special interest to my out-of-state readers. The insurance exchange set up by the Legislature when the MA health care access bill was passed has gotten very good grades. The folks there have had many things to balance, and they have done it thoughtfully. This report was posted on April 22 by Glen Shor, the current Executive Director. He succeeded Jon Kingsdale last April.
April showered us with reasons to be optimistic about the state of health care reform in Massachusetts.
Faced with projected 11% membership growth in the Commonwealth Care program next year as people lose unemployment benefits – and no additional resources to cover that growth – we encouraged our Medicaid managed care organizations to deliver high-quality, cost-effective coverage for less. They came through for the taxpayers with savings of $80 million, meaning that our members will not have to face the prospect of benefit reductions or unaffordable co-payments.
There was also good news for small business owners looking for an easy way to find affordable health insurance for their employees. Starting in July, we are eliminating all up-front fees for purchasing coverage through the Health Connector and will be launching a wellness program and premium discounts for qualifying small businesses. Within a few months, we will also be expanding the choice of health insurance carriers available to small businesses through our easy-to-use, online shopping experience – and even adding an additional carrier for individual purchasers. Our unsubsidized Commonwealth Choice program has doubled in membership over the past year-and-a-half, and these upgrades should make it an even more appealing tool for comparing options and choosing coverage that best suits one’s needs.
And, of course, the fifth anniversary of Massachusetts health care reform was officially marked by Governor Patrick and others at the Dorchester House this month. While we are proud of the fact that 98.1 percent of our residents and 99.8 percent of our children have coverage, the event poignantly showcased that reform isn’t just about numbers. It’s about helping people. We’re succeeding on both fronts.
On the national scene, the Massachusetts experience continues to be closely examined as other states begin to develop their health insurance Exchanges. Partnering with MassHealth and the University of Massachusetts Medical School, we were successful in obtaining a $35.6 million three-year federal grant that will not only help us share our technological knowledge and practices with other New England states but also improve our web-based shopping experience for Massachusetts consumers and small businesses.
Medicare Announces Rules For Quality Bonuses To Hospitals
Medicare took its broadest step yet in moving away from its traditional hospital payment method, finalizing a plan to alter reimbursements based on the quality of care hospitals provide and patients’ satisfaction during their stays.
The initiative is the beginning of a transition from paying hospitals on the basis of the amount of care they provide. Many health care researchers believe this fee-for-service system has encouraged unnecessary care, driving up costs and giving hospitals no incentive to economize.
Medicare’s new “value-based purchasing” program was mandated in last year’s health care law. It has sparked less discussion than has another experiment to change Medicare’s payment system through accountable care organizations, where a select group of doctors and hospitals get bonuses if they find ways to save money.
But this latest payment change affects twenty times more hospitals than would ACOs. More than 3,000 acute care hospitals will have their payments adjusted starting in October 2012.Continue reading…
